Active NPI
Olivia Clark, RD
- Registered Dietitian
- Fort Wayne, IN
National Provider Identifier
1740648534
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- Practice address
- 3909 New Vision Dr
Fort Wayne, IN 46845-1725 - Phone
- (260) 469-6602
- NPI assigned
- Feb 8, 2016
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | Primary |
Addresses
Primary practice location
3909 New Vision Dr
Fort Wayne, IN 46845-1725
Mailing address
1234 E Dupont Rd Ste 1
Fort Wayne, IN 46825-1545
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1454889600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1454889600000",
"number": "1740648534",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1234 E DUPONT RD STE 1",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468251545"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3909 NEW VISION DR",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468451725",
"telephone_number": "260-469-6602"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "OLIVIA",
"credential": "RD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-02-08",
"last_updated": "2016-02-08",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Wayne, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.